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Web based E-Referral forms


Preferred form for Allied Health professionals and Dentists.

Click on links below for


Allied Health E-Referral

Dental E-Referral

General E-Referral

MRI for GPs E-Referral

BD E-Referral

Nuc Med E-Referral (inc GPs)



To use these forms you will need to supply the user name you use to access our PACS system or a RIS ID. If you do not have one please contact us to arrange.

E-Referral PDF forms


They will allow you to create a referral and email it direct to us. Once received we will contact the patient to arrange an appointment.


Please save to your desktop and open in Acrobat or similar as they will not work in some browsers.


North Coast Radiology

General Imaging Request E-Form

MRI GP E-form

MRI Liver E-form

MRI Multiparametric Prostate E-form

BMD Request E-form

Allied Imaging Request E-Form

Chiro Imaging Request E-Form

Dental Request E-form


Clarence Valley Imaging

MRI GP E-form

BMD Request E-form

Dental Request E-form

Upload & Send Scanned Referral

If you already have a referral it can be uploaded here.

Upload referral
Please enter your full name here
Region *
File Upload *

Maximum file size: 10MB


What does this mean for you and your patients?


  • No more urgent calls to your practice requesting reprints of referrals as we would have received it electronically direct from your practice.
  • Radiology referrals generated during a Telehealth consult can be emailed directly to North Coast Radiology and the patient.
  • Patients will not have to initiate the booking process which will mean greater follow up and completion of requested investigations for clinical correlation.
  • Less on hold wait time for both patients and referrers.
  • Efficient, accurate booking and preparation process as NCR will have the information required, without relying on the patient to interpret medical terminology.
  • Once the appointment has been initiated by our clerical staff, the patient  will be sent a copy of the referral with the appointment date & time, branch details and any preparation.


The PDF versions also have…


  • Hyperlinks to extra information for each modality, including up to date Medicare criteria and Imaging Pathways.
  • Google maps links for each NCR branch.